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Management of patients with metastatic breast cancer

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Abstract

Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the third-line setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations with HER2 antagonists are associated with significant clinical activity.

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Authors and Affiliations

  1. Oncology Department, Hospital Universitario Canarias, S/C Tenerife, Islas Canarias, Spain

    Josefina Cruz Jurado

  2. Oncology Department, Hospital de Manises, Valencia, Spain

    Paula Richart Aznar

  3. Oncology Department, CH Ourense, Galicia, Spain

    Jesus García Mata

  4. Oncology Department, Hospital de Cabueñes, Asturias, Spain

    Roberto Fernández Martínez, Ignacio Peláez Fernández & Teresa Sampedro Gimeno

  5. Oncology Department, Hospital de Basurto, Bilbao, Spain

    Elena Galve Calvo

  6. Oncology Department, Hospital Clínico de Zaragoza, Zaragoza, Spain

    Laura Murillo Jaso

  7. Oncology Department, Hospital Ernest Lluch, Calatayud, Zaragoza, Spain

    Eduardo Polo Marqués

  8. Oncology Department, Hospital de León, León, Spain

    Andrés García Palomo

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  1. Josefina Cruz Jurado
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  2. Paula Richart Aznar
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Cruz Jurado, J., Richart Aznar, P., García Mata, J. et al. Management of patients with metastatic breast cancer. Adv Therapy 28 (Suppl 6), 50 (2011). https://doi.org/10.1007/s12325-011-0046-9

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